Nasal septum morphology in human fetuses in computed tomography images

Correlation of maximal nasal septal deviation with deviation at the maxillary insertion

PURPOSE

It is unclear if septal deviation at the insertion points to the nasal cavity is associated with the overall septal deviation. This study aimed to assess septal deviation at the cribriform plate (CP) and maxillary crest (MC) using CT scans and to see if there was any correlation with overall septal deviation.

METHODS

All consecutive CT sinus scans between January 2020 and December 2021 were retrospectively reviewed. Patients were excluded if they had a history of head, nasal or facial trauma, or any previous nasal surgical procedure. Angles between the septum and MC and the septum and CP as well as maximal angle of septal deviation (MSD) were measured.

RESULTS

A total of 70 scans were included in the final analysis. The mean MSD was 8.14°. The mean septal deviation was 0.89° at the CP and 2.02° at the MC. The correlation coefficient between the deviation at the CP and MSD was 0.025 and between the deviation at the MC and MSD was 0.321.

CONCLUSION

Our data reveal a positive correlation between septal deviation at the floor of the nose and overall septal deviation; this was not observed at the septal deviation at the roof. This could be explained due to the inherent tilt in the cribriform plate or by earlier ossification and fixation of the septum during its development at its insertion to the roof, thereby allowing further growth and potential for deviation of the lower part of the septum and its insertion to the floor.

Nasotracheal intubation for airway management during anesthesia

Nasotracheal intubation is used as a basic method for airway management, along with orotracheal intubation under anesthesia and intensive care. It has become an effective alternative method to orotracheal intubation with increased benefits of offering better mobility and surgical field in oral and maxillofacial surgery and possibly in trauma and critically ill patients. Nasotracheal intubation is performed through a relatively narrow nasal cavity; therefore, additional precautions are needed. Accordingly, nasotracheal intubation methods have evolved over the years with accumulated clinical experience and improved instruments to facilitate safe intubation with reduced complications. Therefore, in this review article, we summarize the basic anatomy of the nasal airways to clarify the precautions, delineate the history and development of various methods and instruments, and describe the indications, contraindications, complications, and preventive methods of nasotracheal intubation.

Morphometric Analysis of Sphenoid Sinus in Patients With Nasal Septum Deviation

This retrospective study aimed to assess the association of the volume and types of the sphenoid sinus with deviated nasal septum by analyzing multislice computed tomography images. A total of 93 patients with a deviated nasal septum and 70 healthy controls were included in the study. Patients with sinonasal morbidities other than deviation were excluded. Three-dimensionally reconstructed computed tomography images of the study participants were acquired. A total of 326 sphenoid sinus volumes from the patient and control groups were obtained and compared between the groups. Sphenoid sinus volumes and the angle of the deviation were measured for standardization and assessment of the severity. Deviated nasal septum was found on the right in 49.5% (n = 46) and on the left in 50.5% (n = 47) of the study participants. Deviation angles were in the range from 7.2° to 22.4° and the mean value was 13.2° ± 5.0°. The measured volumes were in the range from 1.8 cm to 9.6 cm with a mean of 4.8 ± 1.5 cm. In the control group, the median values for the sphenoid sinus volumes were 4.40 cm (0.80-8.90 cm) on the right and 4.20 cm (0.90-8.70 cm) on the left. In the study group, sphenoid sinus volumes were found to be statistically significantly different between those on the ipsilateral and contralateral side of the septal deviation. Sphenoid sinus volumes were significantly smaller on the same side with septal deviation compared with those on the contralateral side. There was no statistical relationship between the presence of septal deviation, age and gender, and the type of sphenoid sinus.

Is there a relationship between sphenoid sinus types, septation and symmetry; and septal deviation?

In the present study, we investigated whether there is a relationship between sphenoid sinus (SS) types, septation (lobulation) and symmetry; and septal deviation (SD) by multidetector computed tomography (MDCT). Paranasal MDCT images of 202 subjects (131 males, 71 females), between 10- and 88-year-old, were included into the study. SS type (conchal, presellar or sellar), SS symmetry, SS septation (lobulation) and SD were evaluated by MDCT images. In the present study, in both males (83.2 %) and females (85.9 %); and in all age groups (80.4-85.7 %), sellar type sphenoid sinus were more detected. Conchal type was detected in two cases of the males (1.5 %) and none of the females. SS was detected mainly as multi-septated (multi-lobulated) (51.9 % in males and 56.3 % in females; in all age groups as 51.0-56.8 %; and both SD (+) and SD (-) groups as 51.2-56.8 %). In subjects with SD, asymmetric SS was detected in 80.2 %. Whereas in SD (-) subjects, asymmetric SS was detected in 50.6 %. Sellar type SS pneumatization is the most detected type in our cases. Presence of SD was related to the higher SS asymmetry values. In SD (-) subjects, SS was detected as symmetric. Nasal septal deformities such as SD may influence the development of the SS pneumatization and asymmetric septation. For well anatomic orientation of the surgeons, good anatomy knowledge and preoperative detailed examination of the CT scans are very important.

Diseases of the nose and paranasal sinuses in child

Diseases of the pediatric nose and nasal sinuses as well as neighboring anatomical structures encompass a variety of pathologies, especially of inflammatory nature. Congenital disease, such as malformations and structural deviations of the nasal septum, as well as systemic metabolic pathologies affecting the nose and sinuses, rarely require medical therapy from an Otolaryngologist. The immunological function of the mucosa and genetic factors play a role in the development of disease in the pediatric upper airway tract, especially due to the constantly changing anatomy in this growth phase. Disease description of the nose and nasal sinuses due to mid-facial growth must also take developmental age differences (infant, toddler, preschool, and school age) into account. Epidemiological examinations and evidence based studies are often lacking in the pediatric population. The wide range of inflammatory diseases of the nose and paranasal sinuses, such as the acute and chronic rhinosinusitis, the allergic rhinitis, and adenoid disease, play a role in the susceptibility of a child to infection. The susceptibility to infection depends on the pediatric age structure (infant, young child) and has yet to be well defined. The acute rhinosinusitis in children develops after a viral infection of the upper airways, also referred to as the "common cold" in the literature. It usually spontaneously heals within ten days without any medical therapy. Antibiotic therapy is prudent in complicated episodes of ARS. The antibiotic therapy is reserved for children with complications or associated disease, such as bronchial asthma and/or chronic bronchitis. A chronic rhinosinusitis is defined as the inflammatory change in the nasal mucosa and nasal sinus mucosa, in which the corresponding symptoms persist for over 12 weeks. The indication for CT-imaging of the nasal sinuses is reserved for cases of chronic rhinosinusitis that have been successfully treated with medication. A staged therapeutic concept is followed in CRS based on conservative and surgical methods. Nasal sinus surgery is considered nowadays as effective and safe in children. Based on the assumption that adenoids are a reservoir for bacteria, from which recurrent infections of the nose and nasal sinus originate, the adenoidectomy is still defined as a cleansing procedure in rhinosinusitis. 69.3% of the children had benefit from adenoidectomy. Comorbidities, such as pediatric bronchial asthma, presently play an even more important role in the therapy of rhinosinusitis; therefore, it is often wise to have the support of pediatricians. In western European countries 40% of children presently suffer from allergic rhinitis, in which pronounced nasal obstruction can cause disturbed growth in facial bones. An early therapy with SIT may prevent the development of bronchial asthma and secondary sensitization to other allergens. Therefore, SIT is recommended in treatment of allergic rhinitis whenever, if possible. The assessment of diagnostic tools is for the examiner not often possible due to the lack of evidence. Rhinosurgical approaches are often described in study reports; however, they lack the standard prospective randomized long-term study design required nowadays and can only be evaluated with caution in the literature.